Editorial: Bioethics, Politics and Slovenly Language: Lessons from History

Bioethics, closely connected as it is with philosophy, is intimately concerned with the intellectual frameworks that shape meaning. For that reason, attention to language is critical when we come to reflect on bioethical issues such as euthanasia/assisted suicide or abortion, both of which are currently topical in New Zealand.

In his work, Politics and the English Language, the famous writer George Orwell writes that the English language “becomes ugly and inaccurate because our thoughts are foolish, but the slovenliness of our language makes it easier for us to have foolish thoughts.” Psychiatrist Robert Jay Lifton, in his ground breaking 1986 book The Nazi Doctors: Medical Killing and the Psychology of Genocide,1 takes Orwell’s observation a step further, identifying and exploring the link between language and the ‘dangerous’ thoughts of the Nazi regime which underpinned the systematic killing of disabled people, Jewish people and others such as the Romani, all deemed to be “unworthy of life”.

Australian psychiatrist Marina Vamos puts it well: "The categorisation of words creates instant bias toward one interpretation or another. Thus, the words we choose not only reflect what we are trying to say, but also control meaning in and of themselves."2

These days, comparisons with what happened in Germany in the 1930’s and 40’s are generally avoided in bioethical discussions, labelled as sensationalist and perceived by hearers as providing a ready-made excuse to discredit whatever argument is being made. However, without suggesting that the shocking actions of the Nazi’s can be equated with the practices of euthanasia or abortion, this part of our history contains important lessons about the way in which society’s attitudes to certain practices can be radically changed through an intentional process of ‘moral reframing’ that is intimately linked to the selective use of language, including the use of euphemisms.

There are at least two (closely related) insights that emerge from a close reading of Lifton’s book that are relevant to the contemporary debates we are having about euthanasia and abortion: the way in which, in the 1930’s, certain key figures in Germany used language (i) to remove the psychological and cultural barriers that previously made the holocaust unthinkable and (ii) to medicalise the process in order to blur if not destroy the bright line boundary between healing and killing.

Lifton identifies as crucial a work published in 1920 by two distinguished German professors in which the concept of killing those unworthy of life is professionalised and medicalised as “‘purely a healing treatment’ and a ‘healing work’” (p.46). Thus emerged a notion of “Killing without Killing” (p. 445). Lifton reports that a “leading scholar of the Holocaust told of examining ‘tens of thousands’ of Nazi documents without once encountering the word ‘killing’” (p. 445). For what was done to the Jews there were different words, words that perpetuated the psychological numbing: “the ‘Final Solution’, ‘possible solutions’, ‘evacuation’, ‘transfer’ and ‘resettlement’ … The word ‘selection’ could imply sorting out the healthy from the sick …” (p. 445). Regarding the “mercy killing” of young infants with deformities, Lifton quotes a German doctor he interviewed: “All was to be understood as a responsible medical process, so that … ‘the parents should not have the impression that they themselves were responsible for the death of this child’” (p. 51).

What can we learn from this, and how is it relevant to the current discussions about euthanasia/assisted suicide and abortion that are happening in New Zealand?

David Seymour’s End of Life Choice Bill provides a classic example of the selective and slovenly use of language to misrepresent what is actually being proposed. In the first instance his preferred term, “assisted dying”, fails to provide clarity about precisely what is being proposed. In the words of one commentator: It “is a vague term and could mean no more than the important service of rearranging the pillows for a dying person”. Secondly, and critically, the term fails to distinguish between ‘euthanasia’ and ‘assisted suicide’, two very different types of life-ending interventions which have vastly different implications and outcomes. Thirdly, the term is grossly inaccurate insofar as Seymour’s Bill does not apply only to persons who are dying – it can be accessed by people with “a grievous and irremediable medical condition … in an advanced state of irreversible decline in capability” who consider their suffering intolerable. Referring to euthanasia and assisted suicide as ‘assisted dying’, because it intentionally disguises what is really happening, is a clear case of promoting “killing without killing”.

Meanwhile, David Seymour’s publicly stated refusal to acknowledge the important ethical distinction between intentionally ending a person’s life and the medically accepted ethical practice of withdrawing or withholding futile treatment is an example of his desire to reinforce the link between medicine and the intentional premature death of people. So too is his insistence that euthanasia/assisted suicide are part of medical health care, illustrated by the fact that his Bill puts doctors front and centre as the direct agents for ending life. In contrast, the idea that euthanasia and assisted suicide are part of medical care is rejected by many, including the Scotland Select Committee which, in 2015, found that both supporters and opponents of the Assisted Suicide Bill it was considering acknowledged that the involvement of healthcare professionals in assisted suicide, even if it were legal, would not be “medical treatment”.3

The same behaviours described above for euthanasia are a feature of discussions about abortion. For example, in September 2015, the International Planned Parenthood Federation produced a pamphlet titled How to Report on Abortion, which states up front: “The way abortion is presented in the media can have a major influence on people’s thinking.” The document then advises journalists to use the terms “embryo” or “fetus” rather than “baby” or “unborn baby/child”; “Pregnant woman” rather than “mother” and speak of “a woman’s right to life and health”, rather than the ‘rights’ of the unborn child.4 In defence of its position the document then argues, without reference to evidence, that “the term ‘unborn child’ is a recent anti-abortion invention and a contradiction in terms. Human rights only begin at birth.” Among other things, this assertion ignores a long-standing and enduring social convention that goes back thousands of years, that of speaking of a pregnant woman as ‘being with child’.

The medicalisation of abortion is also, increasingly, a feature of the debate in New Zealand. Thus, for example, Terry Bellamak, National President of ALRANZ Abortion Rights Aotearoa, has spoken about the need to transform abortion from a criminal matter to a health matter. Similarly, the Law Commission of New Zealand has been instructed by the Justice Minister, Andrew Little, to consider “how best to ensure New Zealand’s abortion laws are consistent with treating abortion as a health issue.” Making abortion solely a ‘health’ issue is of particular concern from an ethical and moral perspective because this terminology puts the whole focus on the woman who is pregnant and thereby obscures the fact that two human lives are involved (a fact not lost on well-known abortion advocate Dame Margaret Sparrow who very recently acknowledged that “both [euthanasia and abortion] involve loss of life”5). Once again, the selective use of language and the employment of a reductionist argument serve to avoid the unpalatable but inescapable reality that abortion involves the intentional ending of a human life – yet another example of “killing without killing”.

Attention to our deep seated and spontaneous moral feelings is an integral part of robust ethical deliberation, part of the process of making a properly informed conscientious decision, and a critical ingredient of moral integrity and moral honesty. If the discussion of controversial issues raises such feelings, then we ought to pay attention to these feelings rather than deliberately ignore them. To use language to avoid the stirrings that are part of our deepest selves is to delude ourselves and to delude others. It is to foster ‘denial’ at both the personal and societal level. The deep moral uncomfortableness that is associated with the ending of life that characterises both euthanasia/assisted suicide and abortion should, rather, be seen as an invitation for ethical pause and deeper introspection.

The alternative is becoming all too common – a cheapened form of ethical discussion and a superficial understanding of the complexity of the issues involved. Whatever laws or policies we embrace, we should be absolutely honest and truthful about what is involved, and it is only the honest naming and describing of our actions that will enable that.

If we really want to embrace euthanasia and/or assisted suicide then let’s call them for what they are – the intentional ending of human life – rather than dressing them up as something more palatable. If we really believe that “any reason for an abortion is a good reason”6 and if we really want to enable abortion for any reason, then let’s call abortion for what it is – the intentional ending of a human life – rather than dress it up as something more palatable.

And if, in using honest and clear language, we encounter doubts arising from our deepest moral sensibilities, then let’s stop and think deeply about the wisdom of the laws being proposed.

We must not forget the lessons of history. Slovenly language goes hand in hand with foolish if not dangerous thoughts. Language should be at the service of truth and wisdom rather than being made the slave of personal or political ideologies.

Dr John Kleinsman is director of The Nathaniel Centre, the New Zealand Catholic Bioethics Centre